Travel Health Knowledge, Attitude and Practices among Egyptian Travelers, Part1; Risk Perception, Health Seeking Behavior and Subjective Evaluation of Travel Health Services in Egypt
Engy M. El-Ghitany*
Department of High Institute of Public Health, Alexandria University Alexandria, Egypt
*Corresponding author: Engy M. El-Ghitany, Department of High Institute of Public Health, Alexandria University, Alexandria, Egypt. Tel: +20-100 178 1333; Fax: +20-34285499; Email: ingy.elghitany@gmail.com
Received
Date: 23 November, 2017;
Accepted Date: 22 December, 2017; Published Date: 30 December,
2017
Citation: El-Ghitany EM (2017) Travel Health Knowledge, Attitude and Practices among Egyptian Travelers, Part1; Risk Perception, Health Seeking Behavior and Subjective Evaluation of Travel Health Services in Egypt J Community Med Public Health 1: 121. DOI: 10.29011/2577-2228.100021
Abstract
Background: international civilian travel globally has experienced continued expansion. Outbound travel is increasing in Egypt. The travel health practice and research in Egypt lag behind both needs and demands. Therefore, this study was done in two parts to assess travel health KAP among Egyptian Travelers.
Methods: this survey was conducted at the departure halls of Cairo International Airport and included 1500 travelers to Africa (excluding North Africa), Southeast Asia or Latin America An interview questionnaire that measures the KAP of travelers inquiring about socio-demographic data, previous travel history, current journey details, perception of travel-associated risks, presence of risks management plans and details about the received pre-travel health services and travel health-information seeking behavior. Subjective evaluation of travel health services and suggestions for improvement were also inquired about.
Results: the travelers were mainly males; 89.3%, less than 40 years (82%), living in urban residence (89.1), married (65.9%), university educated (83.3), traveling for work (69.1%) and their destination was Africa (61.3%), Asia (28.4%) and Latin America (10.3). They had poor travel-associated risk perception and only 13.4% had risk management plan. Less than half (42.4%) sought any information about destination and 11.9% sought health information and their source of information was mainly internet (98.7%). The majority had poor level of various travel related practices including seeking pre-travel health services (87.9%), receiving pre-travel vaccines (91.3%) and using malaria chemoprophylaxis (90.6%). The travel health services were rated good by 0.5% of travelers and bad, very bad or undetermined by 11.4%, 61.3% and 26.9% respectively.
Conclusion: Egyptian travelers,
although mostly educated, had poor travel health perception and practice and
are unsatisfied by the travel health services in Egypt.
1. Introduction
Since
the advent of modern commercial aviation in the 1950s, and over the past 6
decades, international civilian travel globally has experienced continued
expansion and virtually uninterrupted growth [1]. The
number of departures in Egypt was 4,863,000 as of 2014. The inbound and
outbound tourism segments have witnessed a positive growth in 2014, despite the
sluggish growth during the global downturn [2]. Outbound
travel recovered swiftly during 2011 as many Egyptians who could afford, left
the country due to instability. The number of departures was predicted to
increase at an average annual rate of 3% [3]. Since the 1990’s, the number of sciatic articles on
travel medicine has increased almost threefold compared to the preceding
decades, implicating the increase of importance and attention by the medical
profession of this discipline of infectious diseases [4].
Many studies have highlighted the underutilization of pre-travel health advice, the lack of knowledge regarding travel medicine, and the large number of travelers that are unaware of the health risks abroad [5, 6]. The European Travel Health Advisory Board (ETHAB) utilized a knowledge, attitude and practice (KAP) survey in order to assess the KAP associated with travel health. They highlighted a lack of knowledge among travelers, even experienced ones and the poor utilization of the preventive measures [5]. Several consecutive studies have investigated the KAP of travelers, most of them used a standardized questionnaire developed by ETHAB. Almost all of these studies were conducted at international airports in various countries of the world [7-9].
The travel health practice and research in Egypt lag
behind both needs and demands. Almost none is known about where Egyptian
travelers got their travel health knowledge from and how they perceive the
health risks of travel and what measures are taken to avoid potential risks.
Therefore, this study was done in two parts to assess travel health KAP among Egyptian Travelers. In this part 1, we
describe and evaluate the
current travel health seeking behavior, risk perception, different pre-travel
practices and the satisfaction and evaluation of adequacy of pre-travel health
services.
2. Methods
This
survey study was conducted at the departure halls of Cairo International
Airport. The Egyptian travelers were 18 years or older randomly selected from
those whose final destination was Africa (excluding North Africa), Southeast
Asia or Latin America. Using a power of 80% to detect a significant level of
health knowledge among travelers = 23.1 %, [10] Alpha
error= 5%, with a precision of 3%, the minimal required sample size was
calculated by Epi-Info software to be 756. Because no data for Egyptian
travelers are available, we assumed that Egyptians are less knowledgeable about
travel health than Asians (a selected close reference), so we decided to expand
the sample size to 1500 travelers.
2.1 Study Procedure
2.1.1. Development of the Questionnaire: An interview questionnaire that measures the KAP of travelers was developed through internet-based literature search on worldwide KAP studies, guidance by ETHAB standardized questionnaire [11]. and frequent meetings of the authors. The questionnaire inquired about socio-demographic data, previous travel history, current journey details, perception of travel-associated risks, presence of risks management plans, details about the received pre-travel health services and travel health-information seeking behavior. Subjective evaluation of travel health services and suggestions for improvement were also inquired about.
2.1.2. Pilot Study: A pilot testing of the questionnaire was carried out from January to October 2014 at Alexandria fever hospital. The questionnaire was tested on 50 individuals among those being evaluated for blood-borne viral infections (HCV, HBV and HIV) as a prerequisite for traveling to gulf countries. Accordingly, questionnaire modifications were made including rephrasing, adding or removing some questions.
2.1.3. Data Collection: It continued from November 2014 to October 2015. The time spent for interviewing each participant ranged between 35 to 45 minutes, thus the researcher was able to interview 10-15 travelers daily.
2.2.
Statistical Analysis
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Categorical data were presented in frequencies. Quantitative data were described using mean/median and standard deviation. Mann Whitney test was used for non-parametric quantitative variables to compare between two groups, while Kruskal Wallis test was used when more than two groups were compared. Spearman coefficient was done to correlate between two non-parametric quantitative variables. Significance of the obtained results was judged at the 5% level.
A score for perception of travel associated risks was developed by assigning a score of 0 for “not exposed to any risk” answer and a score of 1 for each possible risk answer giving a maximum total sum score of 23. The score of perceived travel associated risks was leveled as follows:
·
Low level of perception of travel associated risks
(0-7)
·
Medium level of perception of travel associated risks
(8-15)
· High level of perception of travel associated risks (16-23)
A Scoring system was also established for each of the travel health related practices including risk management plan, carrying protective measures, seeking pre-travel health services and information, receiving vaccines, using malaria prophylaxis and intent to use prophylactic measures. A Likert-like scale was applied where a score of 0 was given for no or malpractice and a highest score were given to the best practice. The total sum of scores for each parameter questions was grouped into three ranked categories. The lowest was referred to as (poor), the middle was referred to as (fair) and the highest was referred to as (good).
2.3. Ethical Considerations
The study strictly followed the ethical guidelines of Helsinki Declaration and was approved by the High Institute of Public Health Ethics Committee. Participation of travelers was on voluntary basis after getting their written informed consent.
3. Results
The
sociodemographic description of participating travelers is shown in (Table 1).
The
majority of them (78.5%) had no reported chronic medical condition. The
distribution of the travelers according to the current journey details is
illustrated in (Table 2).
Africa was the destination for 61.3% of travelers while Asia accounted for 28.5%. Almost half of the participants (658; 43.9%) had a history of previous travel; Africa (51.8%), Asia (46.5%), Europe (14%), North America (5.6%), South and Central America (0.9% each), and Australia (0.5%). Only 224(34%) of studied travelers with history of traveling abroad stated that they had received any vaccination before their previous travels; meningococcal (59%), yellow fever (55.4%), influenza (1.3%), cholera (0.9%), HAV (0.4%) and HBV (0.4%) vaccines.
Regarding
the previous travel associated health problems; diarrhea was the most
encountered health problem among travelers (39.5%), followed by ear problems
(19.6%) and less frequently fever (7.9%), dizziness (7.9%), syncope (3.8%),
insomnia (3.6%), jet lag (3.5%) and high-altitude sickness (0.8%). On the other
hand, about one third (33.6%) of travelers did not declare any previous
post-travel health condition. About half
of the travelers
(47.5%) did not perceive any travel-associated
risks.
The frequencies of various risk
perception are illustrated in (Figure 1)
The
distribution of travelers according to their travel risks management plan is presented
in (Table 3).
The mean total score of perceived
travel-associated risks was low (2.7). The differences in
total score of travel-associated risks perception according to various
travelers and travel-related factors are shown in (Table 4).
Only 12.1% of travelers sought for pre-travel health services and the mean time between travel and obtaining their health services was 1.74±4.8 days. Two main sources for pre-travel health services were mentioned by travelers namely governmental hospitals and malaria prophylaxis center (40.7% and 78.6% respectively). About 30.8% sought pre-travel health services in traveler's vaccination centers and 13.7% in private hospitals. Only one traveler sought the service in a private clinic.
The main health services received by
travelers were vaccination and prophylactic drugs (70.9% and 78.6%
respectively). Other health services included health education (1.1%),
laboratory investigations (1.1%) and radiological investigations (0.5%). General
medical examinations were done in 14.3% of them.
Seeking pre-travel health services was significantly higher among travelers above 40 years (19.2%, P <0.001). There was no sex or residence predilection for seeking pre-travel health services. Moreover, this practice did not differ significantly among experienced and first-time travelers 11.1% vs. 12.9% respectively, or by the time of trip preparation. However, it was significantly higher among travelers traveling for seeking medical treatment (P<0.001).
Regarding the feasibility of
obtaining the pre-travel health service, 73.6% stated that it was difficult to
get the pre-travel health services either due to farness and inaccessibility of the
services (46.7%), lack of specialized travel clinics (33%), overcrowding
(16.5%), high cost (1.6%) or due to long time routine procedures (0.5%). Less than half of travelers sought any information before
travel, health information accounted for only 11.9% of the general information
sought by travelers. The type of information, barriers, sources and degree of
satisfaction are detailed in (Table 5).
Travel
health related practices were described in general as poor. The details are illustrated in (Table
6).
Inquiry into traveler’s opinion
about the quality of travel health services, 61.3% of travelers stated that the
quality of travel health services is very poor and only 0.5% stated that it is
of good quality. Their suggestions to improve the service are listed in (Table 7).
4.
Discussion
Unlike most European travelers where travelers to tropical countries are usually above 40 years old and the purpose of travel is mostly for leisure [11] travelers from less developed countries [12]. Including Egypt are young (mean age was 33 in this study) and their main purpose of travel is to work. This reflects how important it is for this productive energetic group to keep them healthy. Diarrhea was the most frequent health problem (39.5%) among experienced travelers, a figure that is similar to what was found in other studies [13-15]. Ear problems represented the second most frequent health problem (one fifth) among them which was mainly related to changes in pressure inside the plane itself rather than being caused by injury or infection acquired in destinations [16]. A similar figure (19%) was reported among travelers on a south American expedition [17]. None of the experienced travelers in this study reported respiratory infection in their previous travels which disagrees with many studies stating respiratory infections as a major travel health associated problem [18-19]. However, this may be attributed to recall bias or low perceived severity of flu/common cold as a respiratory disease. Only 7.9% of experienced travelers mentioned fever as travel associated problem. Similarly, in Italy fever accounted for 7% of health problems in returned travelers from the tropics [20] Fever represented 26% and 29% of travel associated problems in the GeoSentinel surveillance and
in German travelers destined to tropical and subtropical zones respectively [21,22]. Only one third of the present study participants claimed that they did not encounter any health problem in their previous travels compared to 74% of American travelers, which could be attributed to better pre-travel health services and awareness in the latter group [23]. Only 34% of experienced travelers had received pre-travel vaccination that comprised mainly of required or highly recommended vaccines namely; meningococcal vaccine received by travelers to KSA for Pilgrimages and yellow fever vaccine received by the travelers to Africa which represented the most frequent previous travel destination (51.8%). The perceived health risk in the current survey was poor and reflected on the absence of risk management plan in 86.6% of travelers. Moreover, only 30.3% of the participants were carrying protective measures. The situation was different among travelers studied in Spain [24] and Peru [12] Where 91.2 % and 47.3% of travelers were carrying medications.
Risk perception is a very important safeguard for self-protection [25]. This was higher among those <30 years despite their poor travel health related knowledge and poor practices. This might be attributed to more apprehension, more concern about the risks and temptations of traveling. This could compel them to express more positive attitudes towards various hazards in destinations.
Moreover, there was higher perception of travel risks among illiterate despite having lower knowledge about travel associated risks. This can be explained by hidden fear and inability to cope with stress and risks [26]. Education provide better opportunities and skills to deal with risks and that might have decreased one’s perception of endangering risks. However, gender, age, destination, and region related travel experience had different impacts on the travelers’ risk perception [27]. However, older age, and higher level of education were predictors of increase travel’s risk perception in KSA [28] and Qatar [29]. Only 12.1% of travelers sought pre-travel health service although, 83.3% are well educated, 89.1% are of urban residence, 72% have satisfactory income and 43.9% of them had previous travel history. This was far lower than what was reported in South African; 86% [30], Spanish; 83.1% [24], European; 40% [11], American; 36% [31], Australian; 32% [9], Dubai; 22.8% [32] and Qatar; 19% [29]. Moreover, in the present study, only 11.9% of travelers sought health information about destination. This explains in part the low risk awareness and perception. LaRocque et al [33], found that 46% of international travelers in Australia did not pursue health information of any type; a lack of concern about health problems related to the trip was the most commonly cited reason which was also the case in our study.
The internet proved to be the most popular source for health information (98.6%) for Egyptian travelers than it was for the Japanese (64.1%) [34], European (24%) [11] or the US travelers (19%) [31]. This reflects the unavailability of professional travel health services and it can be anticipated that the information was unsatisfactory and the quality may vary greatly between sources and within them [11]. Ideally, travelers should seek medical advice at least 4-6 weeks before departure. An important factor for inadequate pre-travel seeking behavior was reported to be the increasing number of last minute travelers who planned their trip in less than 2 weeks [6, 32]. On the contrary in the current study, although the majority had enough time to plan their travel (three weeks or more), 85% and 93.1% of those who had planned their trip more than one month prior to their trip did not seek pre-travel health service or health information respectively and the mean time for obtaining health services before travel for those who did was too short (1.74±4.8 days) The Egyptian travel health services was not satisfactory as 61.3% of participants stated the service was very bad and 26.9% were neutral, unlike elsewhere [9,32] where satisfaction was highly rated.
High proportion would like to know information about diseases in destination (39.1%), despite that 61.7% of them did not know that there are diseases associated with travel. However, some travelers may have been sensitized by interviewing questionnaire that made them more curious about the importance of getting health information and services before travel.
5. Conclusion
Egyptian
travelers to tropical areas are usually young educated males travelling for
work. They generally have poor perception of travel-associated health risks and
eventually do not have risk management plan. A minority seeks health
information before travel and the internet is their main source of information.
Their pre-travel practices are Poor and only one eighth seek any pre-travel
services. The travel health services in Egypt have to be improved and were
evaluated by the travelers as poor.
Figure
1: Types of risks in destination in
travelers who perceived any travel-health-related risks
Socio-demographics characteristics (n = 1500) |
No. |
% |
Gender |
||
-Male |
1340 |
89.3 |
-Female |
160 |
10.7 |
Age in years |
||
- >30 |
538 |
35.9 |
- 30 to >40 |
691 |
46.1 |
- 40+ |
271 |
18.1 |
Min. – Max. |
18.0 – 78.0 |
|
Mean ± SD |
33.10 ± 7.117 |
|
Residency |
||
-Rural |
163 |
10.9 |
-Urban |
1337 |
89.1 |
City of residency |
||
-Cairo |
534 |
35.6 |
-Al-Giza |
276 |
18.4 |
-Alexandria |
172 |
11.5 |
-Al-Beheira |
106 |
7.1 |
-Kafr-Elsheikh |
61 |
4.1 |
-Al-Qaliobeya |
85 |
5.7 |
-Al-Daqahlia |
55 |
3.7 |
-Al-Gharabia |
30 |
2 |
-Al-Fayuom |
13 |
0.9 |
-Damietta |
6 |
0.4 |
-Al-Menoufeya |
14 |
0.9 |
-AL-Sharqeya |
33 |
2.2 |
-Canal cities (Suez, Port Said, Ismaeleya) |
59 |
3.9 |
-Upper Egypt cities (Assuit, Beny Suef, Elmenia, Sohaj, Qenna) |
56 |
3.7 |
Marital status |
||
-Single |
510 |
34 |
-Married |
988 |
65.9 |
-Widowed |
2 |
0.1 |
Presence of offspring |
||
-No |
713 |
47.5 |
-Yes |
787 |
52.5 |
Number of family members |
||
- 2->5 |
891, 59.4 |
|
-14 |
609 40.6 |
|
Min. – Max. |
2.0 – 9.0 |
|
Mean ± SD |
4.28 ± 1.58 |
|
Occupation |
||
-Housewife |
40 |
2.7 |
-Professional (professor, researcher, teacher, lawyer...) |
570 |
38 |
-Employee |
150 |
10 |
-Worker (labor, guard, ...) |
66 |
4.4 |
-Artisanal work (carpenter, smith, plumber, painter...) |
188 |
12.5 |
-Athlete |
152 |
10.1 |
-Religion man |
115 |
7.7 |
-Health care worker (doctor, nurse, pharmacist…) |
123 |
8.2 |
-Trade man |
85 |
5.7 |
-Others (not working, student, military persons) |
11 |
0.7 |
Level of Education |
||
-Illiterate |
9 |
0.6 |
-Less than 9 years education |
81 |
5.4 |
-Secondary |
160 |
10.7 |
-University education and post graduate |
1250 |
83.3 |
Type of education (n=1410) |
||
-Literature |
419 |
29.7 |
-Scientific |
867 |
61.5 |
-Medical |
124 |
8.8 |
Monthly income |
||
-Not enough |
416 |
27.7 |
-Enough |
1073 |
71.5 |
-Enough and saving |
11 |
0.7 |
Table 1: Distribution of the travelers at Cairo International Airport according to their socio-demographic characteristics.
Journey details (n = 1500) |
No. |
% |
Travel destination (country and city) |
||
-East Africa |
211 |
14.1 |
-Central Africa |
285 |
19 |
-West Africa |
254 |
16.9 |
-Southern Africa |
169 |
11.3 |
-South East Asia |
221 |
14.7 |
-South Asia |
125 |
8.3 |
-Asia Others |
81 |
5.4 |
-North Latin America |
25 |
1.7 |
-Central Latin America |
41 |
2.7 |
-South Latin America |
88 |
5.9 |
Type of destination (rural/urban) |
||
-Urban |
1279 |
85.3 |
-Rural |
1 |
0.1 |
-Do not know |
220 |
14.7 |
Altitude of destination |
||
-Do not know |
689 |
45.9 |
-High |
51 |
3.4 |
-Same as sea level |
760 |
50.7 |
Type of accommodation in destination |
||
-Hotel |
641 |
42.7 |
-Private house |
790 |
52.7 |
-Youth hostel |
23 |
1.5 |
-Others (residency in a factory, residency in a hospital, worship places) |
46 |
3.1 |
Purpose of travel |
||
-Tourism |
176 |
11.7 |
-Work |
1037 |
69.1 |
-Study |
3 |
0.2 |
-Seeking medical treatment |
4 |
0.3 |
-Sports |
140 |
9.3 |
-Others** |
140 |
9.3 |
Length of stay in days |
||
Mean ± SD |
115.97 ± 118.748 |
|
Presence of companions* |
||
-No |
295 |
19.7 |
-Spouse |
312 |
20.8 |
-Offspring |
163 |
10.9 |
-Relatives |
37 |
2.5 |
-Friends |
47 |
3.1 |
-Work colleagues |
845 |
56.3 |
-Others (parents) |
3 |
0.2 |
Duration between journey planning and date of travel |
||
-Two weeks or less |
85 |
5.7 |
-Three weeks |
81 |
5.4 |
-1 month |
579 |
38.6 |
-More than 1 month |
755 |
50.3 |
Table 2: Distribution of the travelers at Cairo International Airport according to the journey details.
Travel risk management plans (n=1500) |
No. |
% |
Presence of risk plan for potential risks |
||
-Not perceiving risks |
713 |
47.5 |
-No risk management plan |
586 |
39.1 |
-Yes, for most of them |
86 |
5.7 |
-Yes, for some of them |
115 |
7.7 |
Infection control measures (n=175)* |
||
-Food, drinks sanitation |
166 |
94.9 |
-Vaccination |
87 |
49.7 |
-Masks |
19 |
10.9 |
Sports injuries preventive measures (n=53)* |
51 |
96.2 |
-Sports shoes |
||
-Helmets |
0 |
0 |
-Safety belt |
4 |
7.5 |
-First aid bag |
6 |
11.3 |
Occupational accidents preventive measures (n=19)* |
||
-Protective clothes |
2 |
10.5 |
-Helmets |
18 |
94.7 |
-Ear pieces |
1 |
5.3 |
-Anti-slippery shoes |
1 |
5.3 |
Violence accidents preventive measures (n=98)* |
||
-Commitment to organized program |
69 |
70.4 |
-Commitment to laws |
55 |
56.1 |
-Carseat belt |
23 |
23.5 |
Healthy lifestyle measures (n=146)* |
||
-Personal hygiene measures |
105 |
71.9 |
-Safety rules |
11 |
7.5 |
-Not exposed to sun for long period |
98 |
67.1 |
Carrying protective measures (n=455)* |
||
-Antidiarrheal drugs |
161 |
35.4 |
-Ant allergic drugs |
79 |
17.4 |
-Antibiotics |
178 |
39.1 |
-Drugs for chronic diseases |
120 |
26.4 |
-Malaria chemoprophylaxis |
137 |
30.1 |
-Mosquito repellents |
12 |
2.6 |
-Sun screens |
24 |
5.3 |
-Helmets |
1 |
0.2 |
-Special clothes or shoes |
46 |
10.1 |
-Others** |
36 |
7.9 |
Requirement of special health certificate for the country of destination |
||
-Do not know |
600 |
40 |
-No |
899 |
59.9 |
-Yes |
1 |
0.1 |
Table 3: Distribution of the travelers at Cairo International Airport according to travel risks management plans.
Perception of travel associated risks total score^ |
Test of sig. |
p |
||||
No. |
Mean |
±SD |
Median |
|||
Gender |
z= 4.493* |
<0.001* |
||||
-Male |
1340 |
2.82 |
2.9 |
2 |
||
-Female |
160 |
1.69 |
2.4 |
0 |
||
Age in years |
||||||
-<30 |
538 |
3 |
2.87 |
3 |
KWx2 = 24.774* |
<0.001* |
-30 to <40 |
691 |
2.73 |
2.98 |
2 |
||
-40+ |
271 |
2.01 |
2.84 |
0 |
||
Residency |
||||||
-Rural |
163 |
3.15 |
2.97 |
4 |
z = 2.031* |
0.042* |
-Urban |
1337 |
2.64 |
2.93 |
1 |
||
Marital status |
||||||
-Not married |
512 |
3.26 |
2.87 |
4 |
z = 6.038* |
<0.001* |
-Married |
988 |
2.4 |
2.93 |
0 |
||
Education level |
||||||
-Illiterate |
9 |
4 |
3.16 |
5 |
KWx2 = 29.110* |
<0.001* |
-Less than 9 years education |
81 |
3.92 |
2.97 |
5 |
||
-Secondary |
160 |
3.42 |
2.93 |
4 |
||
-University and post graduate education |
1250 |
2.52 |
2.9 |
0 |
||
Education type |
||||||
-Literature |
419 |
2.25 |
2.66 |
0 |
KWx2 = 16.407* |
<0.001* |
-Scientific |
867 |
2.65 |
2.94 |
1 |
||
-Medical |
124 |
3.63 |
3.32 |
4 |
||
Monthly income |
||||||
-Not enough |
416 |
3.65 |
3.03 |
4 |
KWx2 = 57.728* |
<0.001* |
-Enough |
1073 |
2.34 |
2.82 |
0 |
||
-Enough and saving |
11 |
1.82 |
2.23 |
0 |
||
Medical history |
||||||
-No |
1178 |
2.72 |
2.89 |
2 |
z= 1.079 |
0.28 |
-Yes |
322 |
2.61 |
3.11 |
0 |
||
Previous travels |
||||||
-No |
842 |
3.48 |
2.98 |
4 |
z = 11.685* |
<0.001* |
-Yes |
658 |
1.69 |
2.54 |
0 |
||
Destination |
||||||
-Africa |
919 |
2.98 |
3.01 |
3 |
KWx2 = 24.752* |
<0.001* |
-Asia |
427 |
2.21 |
2.81 |
0 |
||
-America |
154 |
2.35 |
2.64 |
0 |
||
Purpose of travel |
||||||
-Tourism |
176 |
2.34 |
2.85 |
0 |
KWx2 = 5.268 |
0.384 |
-Work |
1037 |
2.83 |
3.02 |
2 |
||
-Study |
3 |
2.67 |
3.06 |
2 |
||
-Seeking medical treatment |
4 |
3 |
3.46 |
3 |
||
-Sports |
140 |
2.33 |
2.21 |
2 |
||
-Others** |
140 |
2.56 |
3.03 |
0 |
||
Presence of health insurance |
||||||
-No |
1152 |
2.82 |
2.96 |
2 |
z = 3.124* |
0.002* |
-Yes |
348 |
2.27 |
2.81 |
0 |
||
KW: Kruskal Wallis test for comparing between the different studied groups z: z value for Mann Whitney test *: Statistically significant ^: Travel’s associated risks total score range (0 - 23) **Others = Parents or husband accompany, visiting relatives, attending conference, making a movie, Quran memorization competition, relief committee, traditional arts competition. |
Table 4: Mean standard deviation and median of the studied travelers’ total score of perceived travel-associated risks by some socio-demographic and travel characteristics.
Travel information (n=1500) |
No. |
% |
Seeking any information about destination |
|
|
-No |
864 |
57.6 |
-Yes |
636 |
42.4 |
Type of general information sought (n=636)* |
|
|
-Weather |
552 |
86.8 |
-Altitude |
120 |
18.9 |
-Rural or urban |
102 |
16 |
-Life styles |
158 |
27.8 |
-Prices |
515 |
81 |
-Crowding |
87 |
13.7 |
-Transportation |
388 |
61 |
-Entertainment places |
225 |
35.4 |
-Crimes rates |
56 |
8.8 |
-Health information |
76 |
11.9 |
-Others** |
42 |
6.6 |
Type of health information sought (n=76)* |
|
|
-Prevalent diseases |
32 |
42.1 |
-Mode of transmission of these diseases |
3 |
3.9 |
-Preventive measures for these diseases |
8 |
10.5 |
-Therapeutic modalities for these diseases |
3 |
3.9 |
-Required vaccination |
66 |
86.8 |
Perceived barriers for not seeking health information (n=1424)* |
|
|
-There was no time |
241 |
16.9 |
-They are not necessary |
217 |
15.2 |
-I will know what I need there |
306 |
21.5 |
-I depend on the companions |
243 |
17.1 |
-I am not susceptible as I received the preventive measures |
89 |
6.3 |
-I do not know that there are health risks associated with travel |
878 |
61.7 |
Sources of pre-travel health information (n=76)* |
|
|
-Travel agency |
3 |
3.9 |
-Tourism offices |
1 |
1.3 |
-Family |
4 |
5.3 |
-Friends, work colleagues |
30 |
39.5 |
-Specialized physician |
4 |
5.3 |
-Pharmacist |
3 |
3.9 |
-Internet |
75 |
98.7 |
-Embassy |
3 |
3.9 |
-Others |
1 |
1.3 |
Degree of satisfaction about received pre-travel health information (n=76)* |
|
|
-Not satisfied at all |
16 |
21.1 |
-Not satisfied |
38 |
50 |
-Satisfied |
21 |
27.6 |
-Extremely satisfied |
1 |
1.3 |
*Multiple response question **Others =Hotels, shopping places, political information, residential places, life expenses, recreational activities, libraries and museums. |
Table 5: Distribution of the travelers at Cairo International Airport according to travel health-seeking information.
Travelers practices |
Levels of practices score |
||||||
(n=1500) |
|||||||
Poor |
Fair |
Good |
|||||
<50% |
50%-75% |
75%+ |
|||||
No. |
% |
No. |
% |
No. |
% |
||
Preparing risk management plan |
1299 |
86.6 |
115 |
7.7 |
86 |
5.7 |
|
Detailed risk management plan |
1468 |
97.9 |
32 |
2.1 |
0 |
0 |
|
Carrying protective measures |
1056 |
70.4 |
353 |
23.5 |
91 |
6.1 |
|
Seeking pre-travel health services |
1318 |
87.9 |
0 |
0 |
182 |
12.1 |
|
Seeking information about destination |
864 |
57.6 |
0 |
0 |
636 |
42.4 |
|
Received pre-travel vaccines |
1370 |
91.3 |
0 |
0 |
130 |
8.7 |
|
Use of malaria chemoprophylaxis |
1359 |
90.6 |
0 |
0 |
141 |
9.4 |
|
Use of malaria chemoprophylaxis as required (right timing) |
1356 |
90.4 |
47 |
3.1 |
97 |
6.5 |
|
Intent to use prophylactic measures |
995 |
66.3 |
427 |
28.5 |
78 |
5.2 |
Table 6: Distribution of the travelers at Cairo International Airport according to the level of Travel health related practices.
Evaluation of travel health service and suggestions about travel health (n=1500) |
No. |
% |
Opinion about the quality of travel health services |
|
|
-Very bad |
919 |
61.3 |
-Bad |
171 |
11.4 |
-Undetermined |
403 |
26.9 |
-Good |
7 |
0.5 |
-Very good |
0 |
0.0 |
Traveler’s suggestions to improve the travel health services* |
|
|
-I do not know |
625 |
41.7 |
-Decline to answer |
272 |
18.1 |
-Suggestions related to travel heath education and public health - awareness |
313 |
20.9 |
-Suggestions related to access to travel heath service |
356 |
23.7 |
-Suggestions related to vaccination and malaria chemoprophylaxis |
47 |
3.1 |
Travelers’ suggestions about the information that they would like to know before travel* |
|
|
-I do not know |
345 |
23.0 |
-Decline to answer |
277 |
18.5 |
-Destination’s climate |
103 |
6.9 |
-Transportation in destination county |
77 |
5.1 |
-Ways of communication |
82 |
5.5 |
-Safety and security |
90 |
6.0 |
-Economic aspects |
255 |
17.0 |
-Religious issues |
39 |
2.6 |
-Tourism information |
190 |
12.7 |
-Culture and language |
34 |
2.3 |
-Information about sanitation |
26 |
1.7 |
-Information related to malaria |
54 |
3.6 |
-Information related to other diseases |
587 |
39.1 |
-Miscellaneous issues |
163 |
10.9 |
Table 7: Distribution of the travelers at Cairo International Airport according to evaluation of travel health service and suggestions about travel health.
2.
The World Bank Group. Indicators
2010. World Bank 2015.
3.
Euro Monitor International. Travel and tourism in
Egypt. Euro Monitor International 2016
14.
Centers for Disease Control and Prevention. Travelers’
diarrhea CDC 2016.
16.
American Academy of Otolaryngology. Ears and altitude. Entnet 2013.
29. Al-Hajri MM (2008) Traveler’s preventive health measures
against infectious diseases and physicians’ awareness toward travel medicine in
Qatar 2007. Master Thesis. Arab Board in Community, Qatar 2008.